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A. Freiherr von Schrenck-Notzing, Die Suggestionstherapie bei krankhaften Erscheinungen des Geschlechtssinnes, mit besonderer Berücksichtigung der conträren Sexualempfindung, Stuttgart: Ferdinand Enke, 1892. Excerpts from Chapter 9 (pp. 149-152) and Chapter 11 (pp. 198-205).

Chapter 9. The Etiologic Significance of Heredity and Upbringing for Aberrations of the Sexual Drive.

The significance of the hereditary portion in anomalies of the sexual sense.
Due to the frequency of its occurrence and the legal provisions concerning coitus-like actions between men, contrary sexual feeling takes up the most room in the literature about anomalies of the sexual sense. On the other hand, probably no other aberration of the sexual drive is able to transform the entire personality and character as fundamentally as sexual inversion. The question of the causes and occurrence of this perversion is subject to controversy even today, as shown by the contradictory expert opinions in the famous case of Lady V.1; in spite of the valuable overview of the etiology provided by Moll,2 including careful consideration of most of the authors, the question still appears as unsettled to us.
The more the number of cases accumulates in which lasting therapeutic results have been achieved, the smaller appears the share attributable, in our opinion, to hereditary predisposition in the creation of these anomalies. The identification and specification of the hereditary factor and the precise determination of the experiences damaging the development constitute the main focus of diagnostic and prognostic assessment. As Krafft-Ebing correctly notes, one should assume a priori that it would be impossible to remove or modify an innate perversion. This is the reason for the bleak prospects offered to such patients by psychiatry textbooks, for example the recent one by Kräpelin.3 He says: "Of course, there can be no talk of treatment of this anomaly which grows with the personality of the human being and is deeply rooted in that personality." But if a complete recultivation of the psycho-sexual state is accomplished in cases which appear to be mainly the result of hereditary affliction, then there are only two options for explanation: either the relative effects of hereditary affliction as opposed to the influences of upbringing have been overestimated, or it is in fact possible to compensate for the calamitous effects of hereditary factors using suggestion.
Therapeutic nihilism is naturally most comfortable with the heredity theory, and the homosexual, who in many cases has no conception at all that he is sick (contrary to Westphal's opinion), finds in it a very welcome means to explain his aberration; in fact, he feels fairly justified in pursuing a drive, for the expression of which he feels no responsibility due to its hereditary origin. This is also the reason why the great majority of individuals, who are happy in their orientation, want nothing to do with any treatment. Usually it is not the anomaly of their feeling that sends them to the doctor; rather it is the fear of conflict with the law, their sexual hypersensitivity which threatens to expose them, or perhaps manifestations of progressive neurasthenia which hinder them in their occupation and in life, which provide the motivating cause.

Hereditary dispositions in general.
If the morals and character of a child were really determined in the mother's womb, only to unfold inevitably in life, then all methods of child-raising would have to be considered illusory. And in fact, even hereditary inclinations are nothing other than the residual effect of the habits of our ancestors, acquired through repeated and cumulative action, i.e. capitalized, vigorously persistent activity. The same is seen, as we noticed in the previous chapter, in the historical rise of contrary sexual feeling. Every individual improves and worsens his progeny by the series of actions that characterize his life and which are transformed by habit into hereditary dispositions for his descendants. The mechanism of heredity and our intelligence continuously impact one another. Habit becomes a racial instinct through heredity, insofar as action, first performed in the past as a reflex in the process of adaptation to the environment, and then repeated, can become typical for the future.
Racial morality is the prerequisite for our progress and self-preservation; upbringing must influence our hereditary moral and immoral tendencies toward this end, that is, in order to strive for control over our animal instincts. The training of centuries is genetically fixed in our current generation, and yet we see the power of persistent atavistic racial instincts; thus the warlike lust expressed even today in the duel is a natural result of the fights of our forefathers. And yet, every hereditary disposition requires a specific stimulus in order to become active in reality. This alone indicates the enormous power attributable to upbringing in the selection of the influences impacting on us. Every organism passes through different development and regression processes depending on the most varied adaptations that the fight for survival brings with it. Not only physical characteristics (constitution, corpulence, short life) can be inherited, but also temperament, resistance to external influences, as well as certain illnesses and dispositions toward illnesses. Within the broad scope of unalterable givens, a sufficiently large space remains for human intervention to have an effective influence. Pseudo-heredity, attributable to children's drive to imitate, must also be taken into account. In many cases, inheritance is a possible, but not at all a certain outcome. A defective disposition of the father can be made up for by appropriate characteristics of the mother.
As even Krafft-Ebing admits regarding contrary sexual feeling, usually only the disposition to sickness is inherited. Whether and to what extent it develops, depends largely on later influences in life. The doctrine of atavism makes it probable that seemingly unaffected generations have carried the undeveloped disposition and passed it on. Of all neurological and mental diseases, the sensitive weakness of the nervous system is most often inherited as a neurological disposition, and can develop into a neurasthenia and become a foundation for nervous disorders, depending on the type and strength of the damages impacting the patient in life. But on the other hand, an appropriate way of life can contribute much toward preventing the development and to a certain degree compensate for the hereditary disposition....

Chapter 11. Psychic and Suggestive Treatment of the Manifestations of Sexual Perversion.

The consciousness of moral duties as a preventive measure with remarks about moral upbringing from the standpoint of suggestion theory.

The main task of prevention in sexual aberrations lies in upbringing. A good moral character is the best preventive means against psychoses. For passions and vices exhaust the brain and alter it materially. By indulging in debauched behavior, and failing to exercise control, many of the mentally ill become accomplices in their illness. The importance for humanity of training moral character is demonstrated by the fact of heredity. However, congenital pathological changes to the brain cannot be influenced either by the entire apparatus of traitement moral or by any other means. The congenital lack of ethical concepts cannot be balanced out by upbringing. In this case, the firm discipline of a well-run institution is in order.
The seeming healing of mental degeneration, such as is reported occasionally, can perhaps with correct diagnosis be explained as significant remission, as occurs with moral insanity. For the original mental degeneration is incurable according to the unanimous judgment of all experts.
In general, however, we are dealing merely with dispositions toward perverse drives; correct upbringing may bring about an improvement and control of the drives. To what degree temperament and character can be influenced by pedagogical means is subject to varying opinions; there is no doubt, however, that artificial influence may be exercised to some degree on the hereditary instincts.4 If the concept of suggestion is taken in its broadest sense, then all upbringing can be viewed as an ensemble of coordinated, well-considered "suggestions." This ensemble consists not only of the lessons from parents and teachers; rather, customs, religious belief, attended entertainment, and companionship have unnoticed and to some extent latent effects on the brain, and determine our habits. While upbringing cannot create a genius, it can certainly develop one.
Moral health is more important for the progress of the individual and the race than intellectual qualities. A misled moral instinct leads to regression and dissolution. For this reason, the formation of moral duties can be viewed as a necessary result of individual development. Even the Darwinian selection of the useful, for example in the social life of animals, aims by sexual reproductive choice toward the development or control of some internal skill or property, albeit in the broad sense.
Our actions are guided by what we call "duty"; this is the result of morality and contemplation, the product of an induced harmony between our prevailing inclination with the formula suggested to us by the influences of upbringing. It suffices for children that this or that good characteristic is foisted on them, that is, noticed in them, in order to cause the children to justify this faith. Every image called forth in consciousness strives for its realization through action. One must convince the child that it is morally free and master of itself. The opposite of this is moral abulia, unwilled surrender to whatever impulse happens to be present at the moment. To foist bad characteristics on a child, on the other hand, to inflict undeserved criticism on it (compare case history 67), is to call forth the opposite result, to assign it to the bad, and to develop the bad. Often children are unaware of the bad thing that they did. In such cases, one must convince the child that it did not really want to do the act committed, but rather it made a mistake. Thus, precisely as in hypnosis, one must prompt those characteristics in the child that one wishes it to possess. One of the most powerful means of suggestion is public praise and self-praise; daily experience shows that one can improve individuals in reality by that means alone. The discontinuation of the bad, which may have started for external reasons in the beginning, ultimately becomes a habit, and the simultaneous diversion of the attention to the good makes its contribution toward modifying the conviction. And thus, too, an inner transformation may come about.
Suggestion is merely the introduction of a corresponding belief which is to be realized; the moral effect of suggestion consists of the art of convincing an individual that he is and can be different than he is. Thus one must convince children that they are only capable of doing good, and completely incapable of doing bad. Suggestions in the first years of life are the most powerful of all. Good and bad instincts lie in every human being; one must simply guard against giving the child the formula for the bad instincts. The consciousness of bad inclinations, of perverse orientations in the sexual life, generally reinforces them. That is why homosexuals [Urninge] seek to motivate, or justify, their passion, as we have seen, with the help of the theory of Uranism promoted by Ulrich. The child-raiser must also awaken the conviction that the individual is capable of understanding his actions. To make someone believe he is a fool, incapable of doing this or that action, is to systematically cultivate stupidity. Self-confidence must be raised by assurance. Through the independent solution of challenges, the child gets accustomed to being able to do what it sets its mind to, to training its will. Unfortunately, so many people, specifically neuropaths, lack self-confidence, as daily medical observation shows. Mistrust of oneself finally becomes complete inner helplessness. The belief that one is perverse due to an original brain disposition thus subverts any resistance against the sensual drives. Indeed, an excessive feeling of defectiveness can lead to complete moral paralysis and to suicide.
The main goal of upbringing thus lies in creating a series of habits by direct verbal persuasion, by actions, by imitation, and by admiration. Parents, teachers, and child-raisers have a powerful effect on children through their example; for the child always models itself after the persons in its environment. Therefore, they must be morally higher than the child itself. A firm will oriented toward righteousness and goodness impresses children; what they find most awe-inspiring, they imitate. That is how an example of goodness can truly improve an individual. Not mechanical obedience, like in a dressage, but rather conviction and guidance by authority are the correct factors in upbringing. Once upbringing has succeeded in creating good habits, then its further task is to awaken the belief that these habits are valuable.
Every occupation, every social condition, has a pedagogical effect. It forces us to act in conformity with a general idea. Our behavior is always adapted to social conditions. This results in a modification of our hereditary tendencies as well. Regular employment has a general moralizing effect. Unemployment, on the other hand, lifts a whole series of social constraints from the individual and leaves him to his individual inclinations and hereditary effects. The idea of sociability should therefore be imprinted on the child from youth on as vigorously as possible. The ideal of humanity must strive towards a transformation of hereditary instincts. Moral and social suggestions may prevent, in the sense given here, the formation of a fixed idea, regardless of whether it is a crime or a perversion.
Unbalanced characters often lack altruistic feeling (e.g. complete lack of empathy in criminals). Even if such feeling were present only rudimentarily in an otherwise unfortunately predisposed person, training could develop this feeling and thus establish the balance.
Well-organized and regulated suggestions are capable of suppressing or promoting the effects of heredity, regardless of whether they are applied in a sleeping state (hypnosis) or waking state. For nothing occurs in hypnosis that could not also happen more or less, if only rudimentarily, in the waking state. Thus, suggestion is not an isolated and strange phenomenon. We are all susceptible to suggestion, and social life can be viewed as a state of equilibrium between opposing suggestions. The capacity of personal resistance against suggestion varies considerably, depending on individual characteristics. The suggestive motivation can be interpreted as a forced feeling in the nascent state; it takes up the fight to some degree as a rebel against pre-existing vigorous inclinations and in the moment of suggestion aims toward enveloping the entire mental life in the fixed idea, which imprints itself more and more on the brain. At first the suggestion always calls forth a temporary effect, which can only become a habit for the individual through cumulative impact, i.e. frequent sessions of hypnosis. The effect of the suggestions in our childhood extends throughout our life. Thus suggestion represents the means by which a passive organism attempts to balance itself against an active one. The trusting state of a child is comparable to the nonresistance of a hypnotized subject. However, the human being believes the strongest what he persuades himself of, so that auto-suggestions often mount the most effective resistance to therapeutic promptings. The power to suggest ultimately becomes the ability to assure. The true ring of conviction has the greatest suggestive power. The persons who seem to be the most assuring, through body movement and accent of speech, are the best hypnotists. A forceful will impacts weaker natures like a kind of commando and awakens corresponding feelings. Without the expectation of a particular result, without belief in oneself, no activity will come about. The consciousness of acting is basically the same thing as the belief that one acts. Doubt can even disturb common reflexes. Conscious life thus rests in part on a relationship that one has with oneself.
Virtue and moral consciousness are not innate; we can only inherit the disposition to goodness, to benevolence, or to cruelty; upbringing has more control in the moral arena than in the intellectual. Every person comes to a point in life when he formulates rules for his behavior, which vary according to tastes, preferences, habits, and needs. The criminal and the philanthropist are determined by constant rules which basically represent the theoretical formula of their practice. Moral consciousness develops depending on what germs in the soul of the child are stimulated to become active. Since the practice precedes the theory, it is an important principle of child-raising to direct the action of the children in a moral sense before imprinting principles on them. As Herbart proposes, it is best if children formulate the rules themselves based on their own experiences.
True morality cannot be created by heredity alone. It is created by upbringing, in that our reason takes possession of our selves. Accordingly, the consciousness of a moral duty means the consciousness of an inner and considered ability that guides our actions, the presence of conceptions that seek to realize themselves by their own power, and of feelings that have the well-being of one's neighbor in mind as a result of their development.

Other guidelines for preventing sexual aberrations.

If the child-raising principles presented here and considered from the standpoint of suggestion theory are generally important already for the development of character in children, this is true to an even greater degree for neuropathic individuals, in whom the sexual life appears as a place of least resistance and is driven into perverse directions under the influence of unfavorable circumstances. Sexual education must therefore turn its attention first to ensuring the latest possible emergence of sexual life and the greatest possible suppression of the drive, while observing the guidelines provided in Section I and maintaining very close supervision. The pathogenic stimuli offered by seduction and example must be kept away. As a precaution against a pathological destiny, it should be seen to that the boy accustoms himself to interaction with female companions. Conspicuously intimate friendships between boys and indifference to the feminine require careful monitoring by parents and educators and may raise suspicion.
Train the will to control sensual drives especially in abnormally constituted individuals. However, the imprinting of moral principles, no matter how great its value, must not go to the extent of the ascetic development of a physiologically untenable abstinence. In a case which I observed, this resulted in the artificial provocation of the precise opposite, namely male love. It has already been mentioned that reasonable enlightenment about sexual matters at the time of puberty represents a strong preventive measure. Unfortunately, in most families, this precise point is overlooked. In irresponsible negligence, the destiny of this most important drive for reproduction is left entirely to the randomness of nature. This is where the undifferentiated sexual feeling, the excessive masturbation, the cultivation of perversions comes from. Ask such diseased individuals, who explained their suffering to them. It was almost never parents and educators, but instead, usually popular books, friends, etc. I believe that, even in severe forms of sexual perversion, help and possibly healing is possible as long as the individual is still in the process of development. The sooner the treatment of the person gone astray can take place, the better the prognosis.
In the case of a certain ethical weakness, an existing incapacity to form inhibitory counterconceptions, one should aim to promote the closest possible association of such individuals with normally constituted and strong-willed comrades, to whom passive natures easily adapt themselves. Tarnowsky believes that light ridicule of boys who show a preference for female dress and occupation might be able to arrest the further development of the perverse orientation. In any case, it should be kept in mind that, absent errors in child-raising, the carrying out of feminine inclinations cannot even occur. In all of these issues, as Krafft-Ebing correctly notes, the family doctor can have a salutary and preventive effect, provided he is consulted.

The permissibility of treatment for homosexuals [Urninge].
A question of prevention from the standpoint of the coming generation is represented by the pro and con of treating homosexuals. Moll5 raises the question of whether one should even undertake any medical steps against contrary sexual feeling; after all, pederasty in Schopenhauer's view serves the purposes of nature in that, as a vice of "old men with depraved sexual drives," it prevents undesirable propagation! One could even, says Moll, cause distortion in the expressed effemination of a homosexual!!
The named author does not consider himself authorized to provide an affirmative answer to this question, but rather leaves it to social and legal provisions...

1 Cf. Friedrich's Blätter für gerichtliche Medicin, 1891. No. 1, pp. 32 and 33.
2 Moll, Die conträre Sexualempfindung, Berlin: Fischer's Med. V. H., 1891, pp. 156 ff.
3 Kräpelin, Psychiatrie, 2nd edition, p. 576.
4 Cf. Guyau, Éducation et Herédité, Paris: Alcan, 1890. This book offers correct observations, but appears to us to contain errors regarding the assessment and significance of suggestion.
5 Moll, op. cit., p. 209.